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Biomedical subjects

J C Sánchez-Alvarez

Publications and source records attributed to J C Sánchez-Alvarez.

At least 19 recordsLinked to original sources
PubMed2006

[Neuropsychological intervention in patients with epilepsy].

INTRODUCTION: Neuropsychological evaluation is part of the protocols that are performed in epilepsy surgery units with the aim of selecting suitable candidates for the surgical intervention. DEVELOPMENT: Yet, neuropsychology can be useful for a wider range of purposes in patients with epilepsy. Identifying the cognitive, emotional and behavioural impairments that cause both the epileptic seizures and the possible underlying neuropathologies that trigger them can provide further knowledge of the functional deterioration suffered by epilepsy patients, whether they are candidates for surgery or not, and help guide their possible rehabilitation. The results of this evaluation can also make it easier to carry out the differential diagnosis to distinguish epileptic seizures from other non-epileptic episodes, such as psychogenic seizures. CONCLUSIONS: Neuropsychological evaluation in epileptic patients has increased our knowledge of the higher processes, the brain circuits involved in them and the repercussions that brain injury has on them.

Diagnostic Techniques, Neurological↗
PubMed1998

[Mesial temporal sclerosis (II): clinical features and complementary studies].

OBJECTIVE: To collect clinical data and diagnostic characteristics of the mesial temporal sclerosis syndrome (MTS). Development. CLINICAL FEATURES: In MTS repeated temporal lobe seizures, difficult to control pharmacologically, are seen in patients with neuropsychological defects which can be shown by appropriate tests. There is no pathognomonic clinical data. However, there is frequently: 1. Onset of seizures during childhood (6-10 years old). 2. Presence of some type of aura. The only significantly related types are visceral, olfactory and uncinate. 3. A pattern of conduct typical of ictus, although this is nonspecific: Early ipsilateral manual automatism and contralateral tonic posture. 4. Infrequent generalization. Surface EEG: Acute elements and/or slow waves in interictal recordings localized to the anterior temporal region, either unilateral or bilateral and with independent expression. MR of encephalum: Two typical ipsilateral findings at the electric focus of independent presentation and not mutually exclusive: a) Hippocampal hyperdensity in T2 sequences. b) Atrophy of hippocampal structures. FDG-PET: Interictal pattern of ipsilateral temporal hyperperfusion with typical maximal involvement of the polar region. SPECT-HMPAO: Early ictal and post-ictal pattern of ipsilateral temporal hyperperfusion. CONCLUSIONS: MTS is a clinical syndrome with its own identity from the clinical and diagnostic point of view. Results of the non-invasive tests currently available make invasive tests unnecessary in the preoperative guidelines for these patients.

Cognition Disorders↗
PubMed1997

[Mesial temporal sclerosis (I): histological data, physiopathological hypothesis and etiological factors].

OBJECTIVE: To review the main anatomical, histological, physiopathological and aetiological data characteristic of the mesial temporal sclerosis syndrome (ETM). Development. The typical histological findings in ETM are: 1) A specific pattern of loss of neurone density which includes so-called endfolium sclerosis (considered to be a specific pathological entity always found in ETM), and which is usually accompanied by neurone loss in other hippocampal and extra-hippocampal regions. The CA2 region is never affected. 2) Phenomenon of 'mossy fibers sprouting' which are granulosa cells which form two types of synapses: with the the 'basket cells' which are inhibitory interneurones and with the dendrites of granulosa or pyramidal cells of the CA1, CA2 and CA3 Ammon horn cells which are excitatory cells. CONCLUSIONS: Probably these organic changes are both the cause and effect of repeated convulsions. Participation in this self-perpetuating circuit may be due to recognised risk factors of ETM (head injury, CNS infections, febrile convulsions in early stages of development) which cause, first of all, death of neurones of the dentate gyrus cells followed by reduced inhibitory activity of the 'basket' cells and therefore sustained hyper-excitability of the pyramidal cells (especially in the CA3 regions), which are responsible for complex partial seizures and massive liberation of glutamic acid. Glutamic acid can cause death of neurones of the granulosa cells of the dentate gyrus, thus closing the circuit. This hypothesis explains the progressive nature of the ETM syndrome. When there is pathology of the cortical structure there is another access via to this circuit--by means of cortical discharges of the so-called perforant pathway which stimulates activity of the pyramidal cells and sets off the chain of events described above. This hypothesis explains the so-called 'dual pathology'.

Brain Injuries↗
PubMed1996

[Callosotomy in the treatment of drug-resistant epilepsy].

At the present time corpus callosotomy is a valuable option in the management of some patients with drug-resistant epilepsy who are not candidates for resective procedures. The records of six patients who underwent callosotomy at 'Hospital Virgen de las Nieves' (Granada, Spain) in the past four years were retrospectively analyzed. The patients all had intractable primary or secondarily generalized seizures, were severely handicapped by its frequency and nature (especially with drop attacks and multiple injuries) and were not suitable for other surgical procedure. The results of surgery (five anterior callosotomies and one subtotal section) are described after an average follow-up period of 2.5 years. Overall, four patients achieved significant improvement (at least 50% reduction in seizure frequency, severity, or both, affecting quality of life), with a marked reduction (> 75%) in two of them. There was no clinical deterioration, significant surgical complication nor relevant additional long-term neuro-psychological deficit in any case. Previous studies have been reviewed mainly to find those prognostic factors associated with a better seizure outcome or with the occurrence of complications. The best results are obtained in those patients with drop attacks (including atonic seizures) as the most frequent and disabling seizure type. According to the type of epilepsy, patients with localization-related epilepsy (especially when symptomatic of a focal brain damage) and those with the Lennox-Gastaut syndrome are the most likely to benefit from the procedure. It is suggested that, in the first place, a two-thirds anterior callosotomy should be performed particularly with atonic seizure are the most frequent seizure type. We may proceed with completion of callosal division as a second stage in those patients in whom a significant improvement has not been observed. In severely retarded patients with multiple seizure types, one-stage complete section may be performed. The procedure is relatively safe, with a low incidence of morbidity and clinically significant long-term neuro-psychological deficits. Further larger clinical studies are necessary to elucidate many aspects which are still unresolved. More uniformity would be desirable in the evaluation of patients, surgical technique, follow-up and presentation of results.

Adult↗
PubMedDate not supplied

[Diagnosis of mesial temporal sclerosis with magnetic resonance imaging].

INTRODUCTION: Mesial temporal sclerosis (MTS) is a progressive drug-resistant epileptic syndrome which requires rapid, effective diagnosis and treatment. Histologically there is atrophy and gliosis of the hippocampus. OBJECTIVE: To establish magnetic resonance (MR) imaging guidelines for correct diagnosis. PATIENTS AND METHODS: We made a prospective study of 78 patients with drug-resistant temporal lobe epilepsy (44 women and 34 men; age 6-66 years, mean 31 years). Using a magnet of 1.5 Teslas paracoronal sections were made of the hippocampus with T1 volumetric with inversion-recovery, FLAIR (fluid-attenuated inversion-recovery) and T2 relaxometry. A control group of 30 healthy volunteers was established. The reduction in volume and hippocampal T2 hyperintensity were considered to be MTS diagnosed on MR. RESULTS: No hippocampal differences were observed among the healthy volunteers. The confidence intervals (mean +/- 1.96 SD) were: right volume: 4.169-5.911 mm3; left volume: 4.097-5.940 mm3; time of T2 relaxation: 98-113 ms. MTS was observed in 42 patients (54%): 24 left, 14 right and four asymmetrical bilateral. The results of the diagnostic validity (sensitivity/specificity) were: T1 volumetric 91/92%, FLAIR 93.5/98% and T2 relaxometry 91/92%. There was atrophy of other extrahippocampal structures in five cases of MTS; 10 patients with MTS (23.5%) had another extrahippocampal lesion associated (dual pathology), particularly migration disorders; 21 patients (27%) had lesions without MTS (tumors, alterations of migration, nonspecific gliosis) and in 15 cases (19%) there were no abnormal findings. A total of 27 patients were operated on: 22 with MTS (21 had diagnostic MR, one case had no abnormal findings), four cases had tumors and one had cortical dysplasia. CONCLUSION: The combination of quantitative techniques (T1 volumetric with inversion-recovery and T2 relaxometry) and FLAIR optimize MTS diagnosis using MR.

Adolescent↗
PubMedDate not supplied

[Analysis of cost minimization of monotherapy antiepileptic treatment in patients with recent diagnosed epilepsy : the situation in Spain].

OBJECTIVE: To analyze the cost of monotherapeutic treatment of patients with newly diagnosed epilepsy. PATIENTS AND METHODS: We analysed the cost of treatment with lamotrigine (LTG), carbamazepine (CBZ), phenytoin (PHT) and valproic acid (VPA) using published data regarding the efficacy and tolerability of comparative clinical trials of monotherapy. We established a model of treatment for newly diagnosed patients during the first 12 months after diagnosis. A panel of doctors reached a consensus on the use of resources, costs and model of treatment in Spain. We made a cost minimization analysis for economic assessment of the data based on the fact that randomized trials indicated that CBZ, LTG, PHT and VPA ware of similar efficacy. Analysis was done as 'intention to treat'. Only direct medical costs were considered. RESULTS: In Spain treatment with LTG is twice or three times as expensive as treatment with the other drugs. Sensitivity analysis showed that variations in the interval of use of resources and of costs (defined by the panel of doctors) did not significantly alter the results. CONCLUSIONS: Treatment with LTG is more expensive than treatment with the classical drugs. In view of the methodological limitations of this study, further analysis is necessary, particularly of the methodology of cost-benefit, to evaluate the economic impact of the new antiepileptic drugs and determine whether their use is justified as drugs of first choice.

Anticonvulsants↗
PubMedDate not supplied

[The surgery of epilepsy].

INTRODUCTION: At the present time the surgery of epilepsy is a safe, effective therapeutic option which should be offered to the patient with drug resistant epilepsy at the right moment to prevent the irreversible negative consequences of uncontrolled seizures. DEVELOPMENT: All patients with drug resistant epilepsy should be surgically assessed. In recent years the concept of surgically remediable syndrome has been introduced to refer to conditions in which surgical treatment gives excellent results: mesial temporal sclerosis, circumscribed neocortical lesions, Sturge Weber syndrome and infantile hemiplegic epilepsy are good examples in which prolonged, unnecessary delay of surgery should not occur. This type of surgery should be undertaken in centres with suitable trained multi disciplinary teams with adequate resources and preestablished guidelines. The clinical history, surface electroencephalogram monitoring, directed magnetic resonance, functional neuroimaging with SPECT and PET and neuropsychological studies are the basis for pre surgical diagnosis. These and other investigations should be done following the guidelines of each centre and the complexity of the disorder in each case. CONCLUSION: Anteromesial resection of the temporal lobe, selective amigdalo hippocampectomy, neocortical resection, hemispherectomy or a variation of it, section of the corpus callosum and multiple sub pial transection are the most usual surgical techniques since good results are obtained with them in suitable cases.

Adult↗
PubMedDate not supplied

[Lipoma of the cerebral convexity and refractory focal epilepsy].

INTRODUCTION: Intracranial lipomas make up approximately 0.1% of all cerebral tumours. They are considered to be congenital malformations, caused by poor differentiation and abnormal persistence of the primitive meninges, which has become adipose tissue during the development of the subarachnoid space. They are usually found in the midline, often in the cisterna pericallosa. It is very unusual for them to be in the fissure of Sylvius and cerebral convexity. Most cerebral lipomas are aymptomatic. Epileptic seizures are the commonest symptom, and are sometimes refractory to treatment. CASE REPORT: A 20 year old man with no previous clinical history. From the age of three years he had frequent senso-motor seizures of the lower half of the right side of his body, which were resistant to anti-epileptic drugs. On magnetic resonance there was an extra axial lesion in the left posterior parietal and parasagittal convexity. This was hyperintense in T(1) sequences, not seen in STIR sequences, and was compatible with fatty tissue. Subtotal removal of the tumour was carried out and the histopathological diagnosis was lipoma. The patient had no seizures in the year after operation. CONCLUSIONS: Lipomas of the cerebral hemispheres are very uncommon. The usual symptoms are focal epileptic seizures, as a result of the cortical irritation caused by close adherence of the lipoma to the cerebral cortex or associated cortical or vascular dysplasias. They have easily recognized characteristics on computerized axial tomography and magnetic resonance. Treatment should be conservative unless it is associated with refractory epilepsy, in which case careful resection may be considered, although this is rarely complete.

Adult↗
PubMedDate not supplied

[Patient aged 45 with refractory epilepsy of the temporal lobe since early childhood].

INTRODUCTION: Temporal lobe epilepsy is the most frequent of the epilepsies related with localization and one of the most refractory to pharmacological treatment. Temporal lobectomy curbs seizures in many of these patients, which improves their quality of life. CASE REPORT: Patient aged 45 who, during early infancy, started to suffer simple partial seizures that later went on to become generalised. These were well under control by adolescence but at 23 they became complex partial seizures that were resistant to different antiepileptic drugs. The patient was submitted to a complete presurgical evaluation and a left anterior temporal lobectomy was performed at the age of 44. After surgery he evolved favourably. The final diagnosis was that he was suffering from mesial temporal sclerosis, associated with a subcortical neuronal heterotopy of the parahippocampal region. We discuss the semiology and the aetiology with regard to this patient and in a general sense, and we also define the foundations upholding the decision to perform surgery, the areas that make up the epileptogenic zone, and the neurophysiological and neuropsychological tests, and the structural and functional neuroimaging that are used to measure those areas. Likewise, the different techniques that can be used in resection of the temporal lobe are analysed. We also set out an etiopathogenic hypothesis according to the histopathological results and comment on a number of related general aspects. CONCLUSIONS: Progress in physiopathological knowledge, the development of diagnostic and surgical techniques, and its high efficiency and low morbidity have consolidated temporal lobectomy as a radical form of treatment for temporal lobe epilepsy that should be performed as early as possible once resistance to medication has been observed.

Diagnosis, Differential↗
PubMedDate not supplied

[Changes in episodic and semantic memory associated with temporal lobectomy].

INTRODUCTION: Temporal lobectomy (TL) is an effective treatment for drug refractory temporal lobe epilepsy. The main neuropsychological consequences of the intervention are changes in episodic and semantic memory. Aim. To study the consequences of right temporal lobectomy (RTL) and left temporal lobectomy (LTL) on episodic and semantic mnemonic functioning. PATIENTS AND METHOD: 27 patients who had undergone TL in the Hospital Universitario Virgen de las Nieves in Granada were submitted to pre and post surgical evaluation by means of a battery of neuropsychological tests that included episodic and semantic memory tests for both verbal and visual material. RESULTS AND CONCLUSIONS: ANOVA analysis was employed to analyse the pre and post surgical changes for the whole group of patients, and Student s t and Wilcoxon s non parametric test were used for each group of RTL and LTL. No deterioration was found in ipsilateral memory after the intervention, that is to say, in the verbal memory of the patients submitted to LTL and in the visual memory of RTL patients. With regard to contralateral memory, that is, the visual memory of patients submitted to LTL and the verbal memory of RTL patients, the ANOVA analyses of the whole group revealed a statistically significant improvement. The analyses performed for the whole group (LTL and RTL), however, did not reveal any statistically significant changes.

Adult↗
PubMedDate not supplied

[Refractory epilepsy in adults].

AIMS: Between 25 33% of epileptic patients continue to present epileptic seizures in spite of adequate treatment with antiepileptic drugs (AED). This fact has led to a gradual development of new AED, a progressive expansion of epilepsy surgery and a great amount of interest in the overall knowledge of patients with refractory or AED resistant epilepsy. METHOD: Refractory epilepsy (RE) can be defined as the persistence of correctly diagnosed epileptic seizures that recur so often that they interfere in patients daily lives, after having received treatment with two best choice AED and an association at maximum tolerable doses for two years, which can be less in very acute crises. There exist factors that allow us to forecast a bad prognosis and diagnostic or therapeutic mistakes that point to a pseudorefractory condition must always be excluded. In treating this disorder, we must confirm that there are seizures, as well as the existence or absence of lesions as a substratum, and guarantee suitable treatment with some basic guidelines. Surgery is currently an efficient, safe form of therapy in a group of patients with RE and must be proposed as early as possible when it is suitably indicated, since it eliminates a high percentage of the seizures. If surgery or other alternative treatment does not control the seizures, in the long run therapy should be optimised to try to eliminate the most aggressive seizures and the chronic intoxication by AED in order to provide a better quality of life. CONCLUSION: New therapeutic resources are needed to prevent the negative irreversible consequences of uncontrolled epileptic seizures

Adult↗
PubMedDate not supplied

[Clinical neuropsychology of the surgery of temporal lobe epilepsy].

INTRODUCTION AND OBJECTIVES: The surgery of epilepsy has become a real alternative for the treatment of patients with drug resistant epilepsy. In this study we review the part played by Clinical Neuropsychology in programmes of surgery for epilepsy, particularly in operations designed to treat drug resistant temporal lobe epilepsy. DEVELOPMENT: Firstly we describe the function of the clinical neurologist in relation to these patients. Then we consider the main national and international forms of assessment. Finally we describe the main findings of neuropsychological investigation regarding the approach to temporal lobectomy. Thus we describe the main presurgical characteristics of candidates for surgery regarding cognition and personality. Similarly we describe what is known of the possibilities of finding the site of the epilepetogenic focus and prognosis of the results and neuropsychological consequences of the operation. Finally, we describe the cognitive results, particularly memory, after temporal lobectomy. CONCLUSIONS: Review of the literature shows how important it is for the clinical neuropsychologist to be involved in programmes of the surgery of epilepsy, studying the patients before and after surgery and assessing prognosis. Clinical neuropsychology is also important for predicting the post surgical neuropsychological results.

Amobarbital↗
PubMedDate not supplied

[Epilepsy clinics].

AIMS: The current level of technological progress in the methods of diagnosis and treatment of epilepsies requires certain resources to be concentrated in so-called epilepsy clinics (EC) or centres. DEVELOPMENT: Although many epileptic patients can be diagnosed and treated by clinicians who are not specialized in epilepsies, those whose diagnosis is not totally sure and those who do not have their seizures completely controlled should be referred to an EC. EC are stratified according to the degree of complexity of the studies and therapeutic measures carried out there, the most important being video-EEG monitoring and epilepsy surgery. Moreover, they can be both medical and medical-surgical EC, and may be basic or a reference in their field. If they are properly adapted to a certain volume of population by gradually meeting the local medical and social requirements until they reach an optimum level of development, they can be extremely effective and efficient. The different regional EC must be connected to one another and cooperate with common guidelines for action that have been commonly agreed to by all the centres. They must also allow a bidirectional flow of patients. Every EC must fulfil certain minimum requirements to guarantee the quality of the health care offered there. CONCLUSIONS: Doctors who attend people with epilepsy, with the support of the health authorities, must promote the setting up and development of EC, in order to achieve the maximum possible control over the seizures and a better quality of life for the epileptic patient.

Ambulatory Care Facilities↗
PubMedDate not supplied

[The Andalusia Epilepsy Society's Guide to Epilepsy Therapy 2005: I. Criteria for starting and discontinuing and the pharmacological bases of antiepileptic treatment].

AIMS: The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. DEVELOPMENT: A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines. CONCLUSIONS: The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

Anticonvulsants↗
PubMedDate not supplied

[The Andalusia Epilepsy Society's Guide to Epilepsy Therapy 2005: II. Chronic therapy with antiepileptic drugs in adults and in children].

AIMS: The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. DEVELOPMENT: A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines. CONCLUSIONS: The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

Adult↗
PubMedDate not supplied

[The Andalusia Epilepsy Society's Guide to Epilepsy Therapy 2005: III. Antiepileptic therapy in special situations].

AIMS: The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. DEVELOPMENT: A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines. CONCLUSIONS: The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

Abnormalities, Drug-Induced↗
PubMedDate not supplied

[The Andalusia Epilepsy Society's Guide to Epilepsy Therapy 2005: IV. General principles of antiepileptic polytherapy and therapeutic strategies in refractory epilepsy].

AIMS: The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. DEVELOPMENT: A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines. CONCLUSIONS: The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

Anticonvulsants↗